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Review Question - QID 565

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QID 565 (Type "565" in App Search)
A 51-year-old female presents with an acute inability to extend her thumb, four months after she was treated with cast immobilization for a minimally-displaced distal radius fracture. What is the most appropriate treatment at this time?

Occupational therapy for strengthening

6%

149/2693

Extensor carpi radialis longus transfer to extensor pollicus longus

4%

106/2693

Extensor pollicis brevis transfer to extensor pollicus longus

3%

68/2693

Extensor indicis proprius transfer to extensor pollicus longus

76%

2045/2693

Primary repair of extensor pollicus longus

12%

312/2693

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A rare complication of non-displaced or minimally displaced fractures of the distal radius treated with a cast is a delayed rupture of the extensor pollicis longus (EPL) tendon. The EPL is the primary extensor of the interphalangeal joint of the thumb and also assists with metacarpophalangeal extension. Extensor indicis proprius transfer to the EPL is the most widely used and reported treatment for this condition.

Magnussen et al. reviewed results of EIP transfer following ruptures of the EPL, with 19/21 good results. None of the cases had any loss of independent index finger extension although index extensor strength reduced to half of that of the contralateral side.

Hove et al. reported a similar satisfaction rate following treatment of 15 patients. In his series of 4,400 distal radius fractures treated over a 5 year period, the incidence of delayed tendon rupture following distal radius fracture was 0.3 percent.

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